Transconjunctival Sutureless Vitrectomy Research Articles

Comparison of Conjunctival Cytological Alterations following Conventional and Sutureless Sclerotomies

Purpose: To assess the alterations in conjunctival impression cytology following 23-gauge transconjunctival sutureless versus conventional pars plana vitrectomy. Patients and Methods: Sixty consecutive patients were enrolled in the study. Conjunctival impression cytology was performed on 30 eyes (of 30 subjects) with 23-gauge transconjunctival sutureless vitrectomy and on 30 eyes (of 30 subjects) with conventional vitrectomy. Conjunctival impression cytology was performed preoperatively on the 1st day and in the 3rd month after the surgery. Impression cytology specimens of each group were graded and scored using a range of 0-3 according to Nelson's method. Results: In the conventional pars plana vitrectomy group, statistically significant alterations in the conjunctival impression cytology were detected on the 1st postoperative day (p = 0.001) and in the 3rd postoperative month (p = 0.001), whereas in the 23-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were observed on the 1st postoperative day. However, no significant changes were observed in the following 3 postoperative months (p = 0.08). Conclusion: The properties of impression cytology were altered in the early postoperative period after sutureless and conventional vitrectomy. These changes were improved in the sutureless vitrectomy group only. Sutureless vitrectomy also had an advantageous effect on the conjunctival cytological changes and conjunctival structure.

Assessment of Closure Competency of Sutureless Vitrectomy Sclerotomies After Scleral Hydration

Purpose: To assess the influence that hydration applied on the sclerotomy edges may have on incisional closure resistance after transconjunctival sutureless vitrectomy (TSV).Methods: Experimental, randomized and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, hydration with balanced salt solution (BSS) was applied on the sclerotomy edges of one of the superior incision sites; no maneuver was performed on the other superior sclerotomy. Intraocular pressure (IOP) was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape.Results: In 45% of cases (36 of 80 eyes), sclerotomies subjected to hydration allowed intraocular fluid escape (p = 0.43). There were no differences when comparing opening pressure values of hydrated and non-hydrated sclerotomies (p = 0.19).Conclusions: Scleral hydration did not demonstrate increase in the sclerotomy closure resistance in our experimental model. Given the widespread use of sutureless TSV around the world, the results obtained in our research, in spite of being negative, may contribute to the knowledge of the behavior of sutureless sclerotomies.

The Effects of the Scleral Suture in 23-Gauge Transconjunctival Sutureless Vitrectomy

Purpose: To evaluate the effects of scleral suture for the sclerotomy wound leakage and the clinical outcomes in 23-gauge transconjunctival sutureless vitrectomy with fluid-air exchange. Methods: A retrospective, comparative chart review of 75 eyes of 75 patients who underwent 23-gauge transconjunctival vitrecomy with fluid air exchange was performed. The patients were divided into 2 groups according to the scleral suture used at the end of the operation, sclera-sutured group and sutureless group. The amount of intraocular gas remnants was measured to compare the degree of sclerotomy wound leakage and the postoperative intraocular pressure (IOP) and reoperation rate were analyzed. Results: The mean IOP on postoperative day 1, 7 and 14 was 15.5 ± 4.0 mm Hg in the sclera-sutured group and 15.8 ± 6.2 mm Hg in the sutureless group, without statistical difference (p = 0.874). The percentage of intraocular gas remnants in eyes on postoperative day 1 was significantly higher in the sclera-sutured group (92.9 ± 9.7%) than in the sutureless group (82.4 ± 16.2%; p = 0.002) as well as on postoperative days 7 and 14. The reoperation rate was not statistically significantly different between the sclera-sutured group (6.5%) and sutureless group (9.1%; p = 0.683) Conclusions: In the cases of 23-gauge sutureless vitrectomy with fluid-air exchange, the scleral suture may be effective to prevent the sclerotomy wound leakage and maintain the intraocular gas longer, but there was no statistically significant difference in the final success rate between the 2 groups. However, as more intraocular gas remained in the sclera-sutured group than in the sutureless group statistically, the scleral suture should be considered in cases that require long-term gas tamponade. J Korean Ophthalmol Soc 2015;56(9):1353-1358

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

BackgroundThe purpose of this study was to investigate factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.MethodsThis study was a retrospective review of 84 patients (84 eyes) who underwent 23-gauge transconjunctival sutureless vitrectomy under gas tamponade by a single surgeon. At the end of surgery, the sclerotomy was massaged to promote self-sealing. Factors influencing massage time were examined using multiple regression analysis. Independent variables were age, surgical time, vitreous incarceration, intraocular manipulation, and axial length.ResultsSignificant factors were intraocular manipulation and vitreous incarceration in the examination of all sclerotomies, age only in the examination of infusion sites, and vitreous incarceration only in the examination of manipulation sites.ConclusionIn sclerotomy performed with gas tamponade using 23-gauge transconjunctival sutureless vitrectomy, intraocular manipulation influenced self-sealing of sclerotomy the most, followed by vitreous incarceration, and then age.

Examination of Self-Sealing Sclerotomy for Vitrectomized Eye under Gas Tamponade in 23-Gauge Transconjunctival Sutureless Vitrectomy

Introduction: To investigate whether a previous history of vitrectomy affects sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. Materials and Methods: This study retrospectively reviewed two groups, a vitrectomized group (seven consecutive cases) and an initial vitrectomy group (82 consecutive cases), who underwent 23-gauge transconjunctival sutureless vitrectomy at Jikei University School of Medicine Daisan Hospital in Tokyo. Factors affecting sclerotomy self-sealing were examined using multiple regression analysis. The criterion variable was massage time, and independent variables were age, surgical time, axial length, vitreous incarceration, history of vitrectomy, preoperative intraocular pressure (IOP), and postoperative IOP. Results: Age (F = 10.4) was the only significant factor. History of vitrectomy was not a significant factor (F = 0.06). Conclusions: Previous history of vitrectomy does not affect sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

The 23G and 20G vitrectomy for patients with diabetic retinopathy

Objective To compare the clinical outcomes and complications between 23-gauge and 20-gauge transconjunctival sutureless vitrectomy for patients with proliferative diabetic retinopathy.Methods 64 eyes of 52 consecutive patients who underwent diabetic vitrectomy were enrolled in this retrospectively comparative study.40 eyes of 32 patients underwent 23G microincision vitrectomy(23G group).24 eyes of 20 patients underwent 20G vitrectomy(20G group).The follow-up time was 6 months.The best corrected visual acuity (BCVA),intraocular pressure (IOP),and incidence of intraoperative and postoperative complications were compared.Results BCVA of both groups at postoperative 1,3 and 6 months improved significantly compared with the preoperative BCVA (x2 =20.32,22.56,18.23,P ＜ 0.01).The I OP of the 23-gauge group at postoperative day 1 was lower than the preoperative IOP (t =2.75,P ＜ 0.01).The Operating time of 23-gauge group was shorter than the 20-gauge group (t =2.71,P ＜ 0.01).There was no significant difference in the incidence of intraoperative and postoperative complications except transient postoperative hypotony,which occurred in 9 eyes(22.5％) of the 23-gauge group (x2 =4.56,P =0.03).Conclusion 23-gauge transconjunctival sutureless vitrectomy appears to be as effective as 20-gauge vitrectomy for proliferative diabetic retinopathy.There is no significant difference between two methods in intraoperative and postoperative complications. Key words: Retinopathy, diabetic, proliferative; Vitrectomy, 23-gauge,20-gauge; Research,comparative

The application of 25G vitreous infusion in phacoemulsification

Objective To evaluate the clinical effect of 25-gauge transconjunctival sutureless vitrectomy (25GT-SV) infusion system in phacoemulsification after pars plana vitrectomy.Methods Under 25GTSV infusion system,phacoemulsification and intraocular lens implantation were performed in 41 cases (42 eyes) of cataract after pars plana vitrectomy.Postoperative visual acuity,intraocular pressure (IOP),subjective symptoms,scleral incision,intra-and post-operative complications were observed.Results All operations were successfully performed.The best corrected visual acuity (BCVA) of 40 eyes improved in different degrees 3 months after operation.The BCVA was ＞ 0.1 in 30 eyes and there was significant difference between before and after operation (x2 =13.77,P ＜0.01).The BCVA of 20 eyes was ≥0.3 and there was significant difference between before and after operation (x2 =12.81,P ＜ 0.01).The visual acuity of 2 eyes decreased because of vitreous hemorrhage caused by original disease of fundus.The mean IOP at 1 day,1 week after operation and at the end of the follow-up were (14.62 ± 0.56) mmHg,(14.82 ± 0.54) mmHg and(14.83 ± 0.57) mmHg,respectively.Compared with the mean IOP(14.86 ± 0.59) mmHg (1 mmHg =0.133 kPa) before surgery,there were no significant differences(t =1.70,0.19,0.40,P ＞ 0.05).After operation,the irritation of all eyes was light and the scleral incision was well closed.No obvious complications were observed intraoperatively and postoperatively.Conclusion In phacoemulsification after pars plana vitrectomy,25G vitreous infusion is a safe and effective method,which can maintain IOP,keep stable anterior chamber and decrease the complications. Key words: Infusion, vitreous, 25-gauge ; Cataract, vitrectomized ; Phacoemulsification

Influence of the Source of Incisional Vitreous Incarceration on Sclerotomy Closure Competency after Transconjunctival Sutureless Vitrectomy

Purpose: To evaluate the influence that the origin of incisional vitreous incarceration may have on the presence of postoperative conjunctival blebs over sclerotomies after transconjunctival sutureless vitrectomy (TSV). Blebs are formed by incisional leakage due to incompetent closure.Methods: Twenty-three-gauge TSV was performed in 83 cadaveric pig eyes. Once each vitrectomy was finished, ultrasound biomicroscopy (UBM) was used to assess the presence of postoperative conjunctival blebs over the sclerotomy sites, as well as the existence of vitreous incarcerated in incisions. Vitreous strands may come from the perisclerotomy area, running parallel to the sclera toward the inner hole of the sclerotomies, or may radiate from the core of the vitreous cavity.Results: Vitreous entrapment was found in 73.9% of the sclerotomies; 43.4% of the incisions showed vitreous strands coming parallel to the sclera (12.9% of them showed conjunctival bleb), 19.7% of the wounds presented vitreous aiming toward the core of the vitreous cavity (2% of them had conjunctival bleb) and 10.8% of the entrances presented both vitreous incarceration sources (none of them showed bleb). Incisions with vitreous entrapment parallel to the sclera were associated with a significantly greater sclerotomy leakage rate.Conclusions: Sclerotomies with vitreous incarceration coming from the core of the vitreous cavity showed a greater incisional closure competency than that observed in incisions with vitreous entrapment coming from the pericannular area; if these results were confirmed in humans, different postoperative suture rates may be expected on sclerotomies according to the vitrectomy degree performed in different areas of the vitreous cavity.

Factors Predicting Duration of Intraocular Gas Presence After 23-Gauge Transconjunctival Sutureless Vitrectomy for Rhegmatogenous Retinal Detachment

To investigate factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy. Retrospective review of 130 eyes that underwent 23-gauge transconjunctival sutureless vitrectomy. At the end of surgery, gas exchange and sclerotomy massage to promote self-sealing were performed. If sclerotomy leakage was suspected despite sclerotomy massage, a suture was placed. Factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy were examined using multiple regression analysis. An F value greater than 2 and P value less than 0.05 were considered statistically significant. Significant factors were axial length (F = 7.08; P < .05) and IOP on postoperative day 1 (F = 4.35; P < .05). Age, operation time, preoperative IOP, and number of sutured sclerotomies were not statistically significant. Factors predicting duration of intraocular gas presence in 23-gauge transconjunctival sutureless vitrectomy were axial length and postoperative IOP on day 1.

Clinical research of silicone oil removal with a 23-Gauge vitrectomy system

Objective To investigate the effects of Oxane 5700 silicon oil removal with 23G transconjunctival sutureless vitrectomy system(23G TSV).Methods Sixty-eight eyes of 68 consecutive patients undergoing Oxane 5700 silicone removal were collected,and were divided into 23G minimally invasive group (35 eyes)and 20G traditional group(33 eyes).Results The silicone oil was removed successfully in all patients,the mean duration of follow-up was (5.61 ± 1.24) months.There were significant differences between 23G minimally invasive group and 20G traditional group in the mean operation time (t =21.582,P =0.000).There were also significant differences between two groups in the wound opening time and closing time (t =28.681,t =29.720,P =0.000).The best corrected visual acuity in 23 G minimally invasive group was better than that in 20G traditional group at one day after surgery,there was significant differences between two groups(F =6.087,P ＜ 0.05).The intraocular pressure (IOP) at one day after surgery in both groups was lower than that of preoperative,there were significant differences between two groups (F =6.087,P ＜ 0.05).During the operation and follow-up,there was significant differences between two groups in the median of days discomfort and conjunctival congestion of the eye(Z =-2.253,-3.628,P ＜0.05).Conclusion The 23G TSV is a safe and effective surgical technique to remove Oxane 5700 silicone oil.Compared with traditional standard 20-gauge vitrectomy system surgery,it is time-saving with less red-eye appearance look and high degree of comfort. Key words: Vitrectomy, system, 23-Gauge; Removal, Oxane 5700, silicone oil

Long-Term Outcomes Following Trabeculectomy Combined with 25-Gauge Transconjunctival Sutureless Vitrectomy in Uveitis Patients

Purpose: To evaluate the efficacy of combined trabeculectomy (TLE) and 25-gauge transconjunctival sutureless vitrectomy (TSV-25) for uveitis patients.Methods: Combined TSV-25/TLE was performed in 9 eyes of 6 patients with vitreoretinal complications and intractable glaucoma. Visual acuity, intraocular pressure (IOP), inflammatory control, and number of hypotensive medications were evaluated.Results: Visual acuity improved in 7 of 9 eyes and inflammation was controlled with a decreased oral anti-inflammatory agent dosage in all eyes. Mean IOP, which was 28.11 ± 4.83 mmHg preoperatively, was significantly reduced (15.77 ± 2.68 mmHg) 5 years after surgery (p = 0.008). The mean number of IOP-lowering medications was 3.33 ± 0.71 before surgery and 1.11 ± 0.92 5 years after surgery (p = 0.007). Two eyes required implant of an Ahmed drainage valve during the follow-up period.Conclusion: Combined TSV-25/TLE can be effective in managing vitreoretinal complications and elevated IOP in uveitis patients.

Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy

To elucidate the early surgical advantages of a 23-gauge trocar combined with a one-directional valve system in transconjunctival pars plana vitrectomies. Early surgical results of 432 eyes of 432 patients (190 female and 242 male) who underwent 23-gauge (23G) transconjunctival sutureless vitrectomies (TSV) were evaluated. Sixty-three patients out of 432 underwent a second operation, 29 of them underwent silicone oil extraction, and 34 had phacoemulsification surgery with the help of vitreous infusion. If any sign of leakage was observed after the withdrawal of the cannulae, a suture was applied at the conjunctiva-scleral opening site. A total of 21 (4.8%) patients in the first operation and 7 (11.1%) cases in the second operation needed suture in at least 1 sclerotomy site. No one had intraoperative hypotony. On postoperative day 1, 37 initial surgery patients and 3 second TSV patients had hypotony; all of them resolved spontaneously 1 week after surgery. No one developed choroidal effusions or detachment. Intraocular pressure spikes more than 22 mmHg in day 1 occurred in 18 eyes after initial TSV; 6 of them had gas and 4 eyes had silicone tamponade. 23G TSV is an effective and safe procedure for both first vitreoretinal surgery and second intraocular surgeries in eyes that had TSV previously.

23-gauge vitrectomy with intraocular foreign body removal via the limbus: An alternative approach for select cases

Purpose:To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23-gauge transconjunctival sutureless vitrectomy (TSV).Materials and Methods:In this prospective, non-comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23-gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any.Results:All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye.Conclusion:The advantages of 23-gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.

Machines and Cutters: Stellaris PC.

The Stellaris PC (Bausch & Lomb) is a versatile platform that allows surgeons to perform both anterior segment and posterior segment surgeries. It was developed based on the Stellaris microincision cataract surgery system and can therefore perform <2-mm coaxial or bimanual microincision cataract surgery in combination with posterior segment surgery. Similar to Millenium, its predecessor, the Stellaris PC has an open architecture with modular design that allows products and instruments manufactured by other companies to be used with the system. Vitrectomy can be performed using the traditional 20-gauge system or with microincision 23- or 25-gauge transconjunctival sutureless vitrectomy systems. The special design of the vitreous cutter with increased port area, improved fluidics, and optimized port open time makes the Stellaris PC an efficient system for performing microincision vitrectomy surgery. This article will describe the design, features, and details of various components of the Stellaris PC, including machine controls, entry site alignment trocar/cannula system, fluidics, and high-speed vitreous cutter, as well as its unique illumination system.

Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment.

To describe the en bloc perfluorodissection (EBPD) technique and to demonstrate the applicability of using preoperative intravitreal bevacizumab during small-gauge vitreoretinal surgery (23-gauge transconjunctival sutureless vitrectomy) in eyes with advanced proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD). This is a prospective, interventional case series. Participants included 114 (eyes) with advanced proliferative diabetic retinopathy and TRD. EBPD was performed in 114 eyes (consecutive patients) during 23-gauge vitrectomy with the utilization of preoperative bevacizumab (1.25 mg/0.05 mL). Patients mean age was 45 years (range, 21-85 years). Surgical time had a mean of 55 min (Range, 25-85 min). Mean follow up of this group of patients was 24 mo (range, 12-32 mo). Main outcome measures included best-corrected visual acuity (BCVA), retinal reattachment, and complications. Anatomic success occurred in 100% (114/114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study (ETDRS) lines] was obtained in 69.2% (79/114), in 26 eyes (22.8%) BCVA remained stable, and in 8 eyes (7%) BCVA decreased (≥ 2 ETDRS lines). Final BCVA was 20/50 or better in 24% of eyes, between 20/60 and 20/400 in 46% of eyes, and worse than 20/400 in 30% of eyes. Complications included cataract in 32 (28%) eyes, iatrogenic retinal breaks in 9 (7.8%) eyes, vitreous hemorrhage requiring another procedure in 7 (6.1%) eyes, and phthisis bulbi in 1 (0.9%) eye. This study demonstrates the usefulness of using preoperative intravitreal bevacizumab and EBPD during small-gauge vitreoretinal surgery in eyes with TRD in PDR.

27-Gauge vitrectomy.

Ten years or more have passed since the current concept of 25-gauge transconjunctival sutureless vitrectomy with a trocar-cannula system emerged. There is no doubt that current microincision vitrectomy surgery with 25- or 23-gauge instrumentation has simplified the vitrectomy procedure and has provided numerous potential advantages over traditional 20-gauge surgery. The established theory regarding surgical wounds is that 'much smaller is better'. Along with the development of new-generation vitrectomy machines with ergonomic instruments, surgeons have been shifting dramatically from 20-gauge systems to 23- and 25-gauge systems over the last years. Thanks to recent innovations and improvements in high-end multifunctional vitrectomy machines and ultrahigh-speed cutters, the development of powerful light sources, and wide-angle viewing systems, several new techniques have also encouraged us to launch the development of a 27-gauge vitrectomy system over the past several years. Similar to the recent evolution in 23- and 25-gauge systems, further development and refinement of the functionality of instruments with a gauge of 27 or more are under way and will continue over the coming years, which in the future will allow us to establish this system for ultra-minimally invasive surgery for the full spectrum of vitreoretinal pathologies.

Comparison of Surgically-induced Astigmatism after Combined Phacoemulsification and 23-Gauge Vitrectomy: 2.2-mm vs. 2.75-mm Cataract Surgery

PurposeThe 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods.MethodsWe studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and ΔKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups.ResultsOne week after surgery, both groups exhibited similar amounts of SIA (-ΔKP[120], 0.40 ± 0.41 vs. 0.51 ± 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-ΔKP[120], 0.31 ± 0.54 vs. 0.56 ± 0.42 D; p = 0.045).ConclusionsIn combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.

Outcome of 23-Gauge Pars Plana Vitrectomy for Pediatric Vitreoretinal Conditions

To evaluate the feasibility and short-term outcome of 23-gauge vitrectomy in children for various vitreoretinal conditions. A retrospective chart review was conducted of consecutive children younger than 14 years who underwent 23-gauge transconjunctival sutureless vitrectomy for various vitreoretinal conditions from January 2008 to December 2011 at a tertiary care center. Thirty-seven eyes of 31 children were included. There were 20 boys and 11 girls, aged between 1.25 months and 14 years (median: 10 years, mean: 7.23 years). The surgical indications were subluxated crystalline lens, retinopathy of prematurity stage 4, post-traumatic cataract with ruptured capsule, vitreous hemorrhage, dislocated crystalline lens, endophthalmitis, retinal detachment with vitreous hemorrhage, dislocated intraocular lens, epiretinal membrane, and increased intraocular pressure after intravitreal steroid implantation. Postoperative complications included loose blood, retinal detachment, early postoperative hypotony, and preretinal bleeding. The 23-gauge transconjunctival sutureless vitrectomy approach in children appears safe and effective.

Optimisation de l’impact financier du passage à la vitrectomie transconjonctivale et à la phakoémulsification par mini-incision

To report the financial impact of using modern lens and vitreoretinal surgical techniques. Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary.